As estrogen levels fall during menopause, estrogen dependent tissue will start to involute and take on the characteristic appearance of estrogen deprivation. Cervical mucus levels diminish and vaginal mucosa regresses during menopause. With aging, the vagina becomes shortened, ruggae disappear, and elasticity is lost. Vaginal secretion becomes scanty. When estrogen is provided, some of these effects are reversed: the cervix may secrete more mucus and the vaginal mucosa may regain lost layers. However, the symptoms often do not disappear completely, in part because the amount of estrogen provided for hormone replacement is lower than circulating estrogen levels during a normal menstrual cycle.
Approximately 40% of postmenopausal women experience atrophic vaginitis or vaginal dryness. During vaginal atrophy, the vaginal epithelium decreases in thickness, hydration, rugae (folds), and blood flow. Causes of atrophic vaginitis include a decrease in the amount of estrogen present both locally and systemically as well as environmental factors such as chemotherapy, antihistamines, smoking cigarettes, excessive exercise, and perineal products (i.e. douches, deodorants, and perfumes). Estrogens or hormone replacement therapies (HRTs) are effective in reducing vaginal dryness. However, possible dangerous side effects include a higher incidence of breast cancer, endometrial cancer, blood clots, nausea, breast tenderness, and headache.
Products that are available over-the-counter include lubricants such as Astroglide and KY Lubricating Jelly as well as moisturizers such as Replens and KY Long Lasting Moisturizer. These products, which are mostly water in composition, provide only temporary relief (1-2 days) for symptoms and provide virtually no long-term benefits to the vaginal tissue.
Therefore, vaginal dryness and regression of vaginal mucosa are problematic, particularly after menopause. Stimulation of cervical mucus production can help alleviate vaginal dryness, and can also augment the action of exogenously administered estrogen to alleviate vaginal dryness. Moreover compositions and methods for counteracting the regression of vaginal mucosa are also needed.